| ORIGINAL REPORTS |
Department of Urology
Norfolk and Norwich Hospital
Norfolk, UK.
CASE REPORT
A 76 year-old male presented with worsening symptoms ofbladder outflow obstruction, with a progressive history of hesitancy, worseningstream and terminal dribbling . Routine pre-operative investigations didnot reveal any significant abnormality except fora plain abdominal X-Ray, that showed considerable prostatic calcification(Figure).At cystoscopy, he was found to have an occlusive looking prostate and theprostatic urethra had a calculus embedded in it.
A transurethral resection of the prostate (TURP) was performedand only 8 grams of tissue were resected. Five large calculi filling uplacunae just below the prostatic surface were found and removed. Histologysubsequently showed Chronic Focal Prostatitis.
The patient re-presented after 6 weeks with retentionof urine. Further cystoscopy revealed large amounts of calculi in the bladder,urethra and in the prostatic cavity. An additional 50 grams of prostaticcalculi were subsequently extracted and the patient was once again ableto void normally.
DISCUSSION
Prostatic calculi are extremely common in men over 50years of age but infrequent in patients below 40 years and rare in children.
Prostatic calculi are usually composed of calcium phosphatestones1 formed either by simple precipitation of prostatic secretionsor calcification of the corpora amylacea. They may arise either spontaneouslyor as a result of inflammation, infection or obstruction.2
99% of all prostates examined at autopsy2,3show calculi mainly in the border zone between the middle and postero-laterallobes of the prostate. Prostatic calculi appear to be unrelated to thedevelopment of adenocarcinoma, but if calculi are present, they are typicallyseen peripheral to the tumors.
Symptoms attributed to prostatic calculi are rare andinclude reduction of the urinary stream, lower back and leg pain,2recurrent passage of calculi after TURP and orchitis.4
Prostatic calculi rarely present as a clinical problemand their diagnosis is usually obtained by plain radiology or transrectalultrasonography.5 Treatment of the calculi is often not required,but usually involves transurethral resection although ESWL with suprapubicpercutaneous extraction6 has been described.
Large prostatic calculi detected pre-operatively in thepresence of small amounts of resectable prostatic tissue should be treatedand extracted as aggressively and completely as possible at the first interventionto avoid the necessity of repeat intervention.
REFERENCES
1. Gawande, A.S.: Brushite Lithiasis of Prostate. B.J.Urol58 (2): 230, 1986.
2. Klimas R., Bennett.B., Gardner WA Jr. Prostatic Calculi:A review. Prostate; 7(1) :91, 1985.
3. Sondergaard G, Vetner M. , Christensen PO: ProstaticCalculi. Acta Pathol. Microbiol. Immunol. Scand; 95(3) : 141-5,1987.
4. Koh K.B.: Symptomatic Prostatic Calculi- A Rare ComplicationAfter TURP. Med. J Malaysia. ; 50 (3) : 280-1, 1995.
5. Dahnert WF. , Hamper UM., Walsh PC., Eggleston JC.,Sanders RC.: The Echogenic Focus In Prostatic Sonograms, With XeroradiographicAnd Histopathologic Correlation. Radiology.; 159(1): 95-100. 1986
6. Melone F., Lardani T., Azzaroli G. et al.: DumbellStone Of Prostatic Fossa After Prostatectomy. A Combined ESWL And SuprapubicPercutaneous Treatment. Acta Urologica Belgica., 64(4) : 27-31,1996.
